Publications

This paper summarizes The American Journal of Drug and Alcohol Abuse special issue and offers suggestions for future steps. People who use alcohol or other addictive substances are much more likely to use tobacco. Yet, clinicians and scientists have long regarded these addiction categories as separate and unrelated. The resultant benign neglect of tobacco use has had disastrous consequences on patients. This special issue is an important step toward remedying that situation. It has reviewed what is known and what more needs to be discovered regarding the co-occurrence of tobacco use disorder (TUD) and other substance use disorders (SUDs). The timing of this special issue occurs at a moment when smoking rates among both adults and youth are at a modern low. But not all segments of the population have benefited from this improvement. In particular, those with a SUD smoke two to four times the rate of the general population and thus suffer disproportionately from the myriad tobacco-induced diseases. The multi-disciplinary contributors to this special issue have reviewed various aspects of the co-occurring disorders. What emerges is a complex portrait. In some categories, the facts are stark, such as the strong association between SUDs and tobacco use and the toll they both extract. In others, such as the emerging new electronic nicotine delivery devices, there are intriguing associations that warrant further investigation. What is clear is that the historic schism between smoking and other addictions needs to be breached in order to improve the health of the public. This special issue should be viewed as a call to action for breaching that schism.

Aquaporin-4 (AQP4)-specific T cells are expanded in neuromyelitis optica (NMO) patients and exhibit Th17 polarization. However, their pathogenic role in CNS autoimmune inflammatory disease is unclear. Although multiple AQP4 T-cell epitopes have been identified in WT C57BL/6 mice, we observed that neither immunization with those determinants nor transfer of donor T cells targeting them caused CNS autoimmune disease in recipient mice. In contrast, robust proliferation was observed following immunization of AQP4-deficient (AQP4) mice with AQP4 peptide (p) 135-153 or p201-220, peptides predicted to contain I-A-restricted T-cell epitopes but not identified in WT mice. In comparison with WT mice, AQP4 mice used unique T-cell receptor repertoires for recognition of these two AQP4 epitopes. Donor T cells specific for either determinant from AQP4, but not WT, mice induced paralysis in recipient WT and B-cell-deficient mice. AQP4-specific Th17-polarized cells induced more severe disease than Th1-polarized cells. Clinical signs were associated with opticospinal infiltrates of T cells and monocytes. Fluorescent-labeled donor T cells were detected in CNS lesions. Visual system involvement was evident by changes in optical coherence tomography. Fine mapping of AQP4 p201-220 and p135-153 epitopes identified peptides within p201-220 but not p135-153, which induced clinical disease in 40% of WT mice by direct immunization. Our results provide a foundation to evaluate how AQP4-specific T cells contribute to AQP4-targeted CNS autoimmunity (ATCA) and suggest that pathogenic AQP4-specific T-cell responses are normally restrained by central tolerance, which may be relevant to understanding development of AQP4-reactive T cells in NMO.

OBJECTIVE

In the United States, Puerto Ricans and African Americans have lower prevalence of breastfeeding and worse clinical outcomes for asthma compared with other racial/ethnic groups. We hypothesize that the history of breastfeeding is associated with increased forced expiratory volume in 1 second (FEV) % predicted and reduced asthma exacerbations in Latino and African American youths with asthma.

METHODS

As part of the Genes-environments & Admixture in Latino Americans (GALA II) Study and the Study of African Americans, asthma, Genes & Environments (SAGE II), we conducted case-only analyses in children and adolescents aged 8-21 years with asthma from four different racial/ethnic groups: African Americans (n = 426), Mexican Americans (n = 424), mixed/other Latinos (n = 255), and Puerto Ricans (n = 629). We investigated the association between any breastfeeding in infancy and FEV% predicted using multivariable linear regression; Poisson regression was used to determine the association between breastfeeding and asthma exacerbations.

RESULTS

Prevalence of breastfeeding was lower in African Americans (59.4%) and Puerto Ricans (54.9%) compared to Mexican Americans (76.2%) and mixed/other Latinos (66.9%; p < 0.001). After adjusting for covariates, breastfeeding was associated with a 3.58% point increase in FEV% predicted (p = 0.01) and a 21% reduction in asthma exacerbations (p = 0.03) in African Americans only.

CONCLUSION

Breastfeeding was associated with higher FEV% predicted in asthma and reduced number of asthma exacerbations in African American youths, calling attention to continued support for breastfeeding.

Shared decision making (SDM) is essential to advancing patient-centered care in emergency medicine. Despite many documented benefits of SDM, prior research has demonstrated persistently low levels of patient engagement by clinicians across many disciplines, including emergency medicine. An effective dissemination and implementation (D&I) framework could be used to alter the process of delivering care and to facilitate SDM in routine clinical emergency medicine practice. Here we outline a research and policy agenda to support the D&I strategy needed to integrate SDM into emergency care.